Claims Examiner - Workers Compensation | Jurisdiction: NV | Licensing: NV
Hispanic Alliance for Career Enhancement, Las Vegas, NV, United States
Claims Examiner – Workers Compensation
Apply your knowledge and experience to adjudicate complex customer claims in an energetic culture.
Deliver innovative customer‑facing solutions to clients representing virtually every industry.
Be part of a rapidly growing, industry‑leading global company known for excellence and customer service.
Leverage Sedgwick’s broad, global network of experts to both learn from and share insights.
Take advantage of professional development opportunities to grow your career.
Enjoy flexibility and autonomy in daily work, location, and career path.
Access diverse and comprehensive benefits for mental, physical, financial, and professional needs.
Essential Responsibilities
Analyze and process complex or technically difficult workers’ compensation claims by investigating and gathering information to determine exposure.
Manage claims through well‑developed action plans to timely resolution.
Negotiate settlement of claims within designated authority.
Calculate and assign timely and appropriate reserves to claims; manage reserve adequacy throughout the life of the claim.
Calculate and pay benefits due; approve and make timely claim payments and adjustments; settle claims within designated authority level.
Prepare necessary state filings within statutory limits.
Manage the litigation process; ensure timely and cost‑effective claims resolution.
Coordinate vendor referrals for additional investigation and/or litigation management.
Use appropriate cost containment techniques, including strategic vendor partnerships, to reduce overall cost of claims for clients.
Manage claim recoveries, including subrogation, Second Injury Fund excess recoveries, and Social Security and Medicare offsets.
Report claims to the excess carrier; respond to requests for directions professionally and timely.
Communicate claim activity and processing with the claimant and the client; maintain professional client relationships.
Ensure claim files are properly documented and claims coding is correct.
Refer cases as appropriate to supervisor and management.
Perform other duties as assigned.
Support the organization’s quality program(s).
Travel as required.
Location
Expected to work in office 100% for training and then in a hybrid schedule.
Qualifications
Education and Licensing: Bachelor’s degree from an accredited college or university preferred; professional certification as applicable to line of business preferred.
Experience: Five (5) years of claims management experience or equivalent combination of education and experience required.
Jurisdiction Knowledge: NV.
Licensing: NV.
Benefits & Development
Flexible work schedule.
Referral incentive program.
Opportunity to work in an agile environment.
Career development and promotional growth opportunities.
Comprehensive benefits including medical, dental, vision, and 401(k) on day one.
Sedgwick is an Equal Opportunity Employer and a Drug‑Free Workplace.
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Apply your knowledge and experience to adjudicate complex customer claims in an energetic culture.
Deliver innovative customer‑facing solutions to clients representing virtually every industry.
Be part of a rapidly growing, industry‑leading global company known for excellence and customer service.
Leverage Sedgwick’s broad, global network of experts to both learn from and share insights.
Take advantage of professional development opportunities to grow your career.
Enjoy flexibility and autonomy in daily work, location, and career path.
Access diverse and comprehensive benefits for mental, physical, financial, and professional needs.
Essential Responsibilities
Analyze and process complex or technically difficult workers’ compensation claims by investigating and gathering information to determine exposure.
Manage claims through well‑developed action plans to timely resolution.
Negotiate settlement of claims within designated authority.
Calculate and assign timely and appropriate reserves to claims; manage reserve adequacy throughout the life of the claim.
Calculate and pay benefits due; approve and make timely claim payments and adjustments; settle claims within designated authority level.
Prepare necessary state filings within statutory limits.
Manage the litigation process; ensure timely and cost‑effective claims resolution.
Coordinate vendor referrals for additional investigation and/or litigation management.
Use appropriate cost containment techniques, including strategic vendor partnerships, to reduce overall cost of claims for clients.
Manage claim recoveries, including subrogation, Second Injury Fund excess recoveries, and Social Security and Medicare offsets.
Report claims to the excess carrier; respond to requests for directions professionally and timely.
Communicate claim activity and processing with the claimant and the client; maintain professional client relationships.
Ensure claim files are properly documented and claims coding is correct.
Refer cases as appropriate to supervisor and management.
Perform other duties as assigned.
Support the organization’s quality program(s).
Travel as required.
Location
Expected to work in office 100% for training and then in a hybrid schedule.
Qualifications
Education and Licensing: Bachelor’s degree from an accredited college or university preferred; professional certification as applicable to line of business preferred.
Experience: Five (5) years of claims management experience or equivalent combination of education and experience required.
Jurisdiction Knowledge: NV.
Licensing: NV.
Benefits & Development
Flexible work schedule.
Referral incentive program.
Opportunity to work in an agile environment.
Career development and promotional growth opportunities.
Comprehensive benefits including medical, dental, vision, and 401(k) on day one.
Sedgwick is an Equal Opportunity Employer and a Drug‑Free Workplace.
#J-18808-Ljbffr